MSCT扫描在进展期胃癌术前评估及分期中的应用价值

目的:评价低张力口服水多层螺旋CT(MSCT)3期扫描对进展期胃癌的诊断、分期及可切除性判断的价值.方法:65例患者口服水,在低张状态下进行动态增强扫描.判断肿瘤诊断及分期,预测手术可切除性,并与手术及病理相对照.结果:本组病例52例行手术治疗,13例MSCT评估为Ⅲ、Ⅳ期放弃手术而行介入和化疗.CT表现为胃壁增厚、软组织肿块、胃壁多层结构破坏.淋巴结及邻近、远处脏器的侵犯及转移分别为40.1%、16.9%和20%.CT分期与手术病理分期相符者43例,胃癌cT分期总的准确率82.7%.结论:MSCT在进展期胃癌诊断、分期及可切除性判断等方面具较高的价值,能够为临床诊治提供有益的指导.     

胆囊癌淋巴结转移的多层螺旋CT分析

目的 探讨胆囊癌淋巴结转移的MSCT表现,以期提高对胆囊癌淋巴结转移的认识.方法 65例经手术病理证实的胆囊癌患者行MSCT三期扫描,分析所有胆囊癌淋巴结转移的CT表现,并与手术病理对照.结果 本组收集65例中,43例共发现淋巴结201枚,其中32例中183枚淋巴结符合MSCT转移的诊断标准;11例发现<1 cm淋巴结18枚,其中阳性3枚,准确性为87%;CT的阳性预测值为91%,阴性预测值为83%.胆囊癌淋巴结转移以肝门和胰头十二指肠旁最为多见,其强化方式与原发肿瘤一致.结论 胆囊癌淋巴结转移是最常见的转移方式,MSCT扫描可以明确胆囊癌的淋巴结转移,有助于术前分期和减少误诊.     

胃充气状态下上腹部增强CT扫描判断贲门癌的可切除性

目的 探讨胃充气状态下上腹部增强CT扫描对贲门癌可切除性的判断价值。方法 77例贲门癌患者术前行胃充气状态下上腹部增强CT扫描，对贲门癌切除的可能性进行预测，将预测结果与手术结果相对照。结果 预测55例能完成根治性手术切除的病人中，53例行根治性切除，2例行姑息性切除。预测22例不宜手术，结果11例手术探查，10例姑息切除，2例根治性切除。其判断贲门癌不能手术切除的阳性预测值为90．9％，阴性预测值为96．4％。结论 胃充气状态下上腹部增强CT扫描对贲门癌可切除性的估价有重要价值。     

多层螺旋CT经肝穿胆管造影及血管造影成像在胆管梗阻病变的应用

目的 探讨多层螺旋CT(MSCT)肝穿胆管造影及血管造影成像在胆管梗阻病变的应用价值.资料与方法 运用16层螺旋CT对45例胆管梗阻病变行胆管造影及血管造影多期扫描,重组胆管系统、肝动脉、门静脉的三维图像, 对病变的部位、性质作出诊断,判断肿瘤与血管的关系,对恶性肿瘤可切除性进行术前评估,并与手术和病理结果作比较.结果 45例胆管梗阻病例的CTA和43例胆管造影成像能满足诊断要求.对照手术和病理结果,定位诊断率为100%;整体定性诊断率为97.8%,恶性肿瘤的定性诊断率为100%.36例手术探查患者中,判断肿瘤与肝动脉、门静脉关系上,诊断符合率分别为91.6%及94.4%.29例接受手术治疗的恶性肿瘤患者中,在评估肿瘤可切除性上,准确率为95%;在评估肿瘤不可切除性上,准确率为88.8%.统计学检验分析,Kappa值为0.795,提示术前评估结果与手术结果一致性极好.结论 MSCT血管和胆管造影检查对判断胆管梗阻病变的部位、性质,门静脉、肝动脉受侵犯情况具有相当高的准确性,在恶性肿瘤特别是高位胆管癌术前可切除性的评估以及制定手术治疗方案等具有重要的参考价值.     

螺旋CT双期扫描对胰腺癌分期的评价

胰腺癌被发现时多已失去手术切除的机会,而且Whipple手术有较高的并发症和一定的致死率,因此术前正确分期有重要的临床意义.螺旋CT双期扫描能有效利用对比剂增强作用,利于病灶的检出和局部侵犯及远处转移的发现,从而更适于胰腺癌的术前分期.本文介绍了胰腺的螺旋CT双期扫描技术,及其对胰腺癌的检出、分期和可切除性评价的价值,并与内窥镜超声和MR做了比较.     

多层螺旋CT判断壶腹周围癌的可切除性

目的:探讨多层螺旋CT(MSCT)判断壶腹周围癌可切除性的价值。材料和方法:回顾性分析经病理证实的35例壶腹周围癌患者的CT表现,并与手术或十二指肠胰胆管造影(ERCP)所见对照。结果:经MSCT检查35例均发现肿瘤,增强扫描肿瘤本身可见不同程度增强,其中16例经图像后处理,35例均清晰显示肿瘤及肿瘤与周围组织、血管的关系。根据MSCT表现判断26例肿瘤可手术切除,19例接受了肿瘤切除术,9例有转移或血管受累征象手术不能切除。结论:MSCT动态增强扫描与三维重建技术相结合能清晰地显示壶腹部肿瘤及其与周围结构的关系,对于壶腹周围癌可切除性的判断及预后有重要的指导作用。     

16排螺旋CT血管成像对腹腔镜下胃切除术的价值

目的 探讨腹腔镜辅助下胃切除术前16排螺旋CT血管造影(MSCTA)评价胃周血管解剖的价值. 资料与方法 24例拟行腹腔镜辅助下胃远端切除术的患者行MSCT双期扫描,其动、静脉期图像采用容积再现重组技术分别行三维CTA. 结果 24例中三维CTA准确显示胃左动脉24例,胃右动脉23例,胃左静脉24例.6例CTA伴有替代肝左动脉.CTA显示胃左动脉、胃左静脉和替代肝左动脉敏感性和阳性预测值均为100%;显示胃右动脉敏感性为100%,阳性预测值为96%. 结论 MSCTA能够准确评价胃的血管解剖,有利于腹腔镜辅助下胃远端切除术.     

贲门胃底癌多层螺旋CT双对比剂充盈增强扫描三维重建

目的 探讨胃双对比剂充盈MSCT增强扫描三维重建对贲门胃底癌应用价值.方法 60例经胃镜及手术证实的贲门胃底癌患者,水对比剂充盈行MSCT平扫、增强双期扫描;碘对比剂充盈行延迟扫描及二维多平面、曲面重建,三维容积成像、CT内窥镜成像.结果 贲门癌6例,贲门胃底癌18例,侵犯下段食管癌12例,胃体小弯癌14例,胃体胃窦癌6例,下段食管胃体胃窦癌4例.病灶厚度9～46 mm.淋巴结转移29例,肝转移7例.浆膜侵犯13例.结论 MSCT双对比剂充盈增强扫描三维重建对贲门胃底癌诊断效果良好,具有重要的临床应用价值.     

16层螺旋CT在宫颈癌临床分期中的价值

目的 探讨16层螺旋CT在宫颈癌临床分期中的价值.方法 经宫颈刮片病理证实为宫颈癌患者51例,治疗前均行东芝AQUILION 16层螺旋CT盆腔平扫及增强.参照FIGO分期方法进行宫颈癌CT分期,并与临床分期进行比较.结果 螺旋CT扫描使26例宫颈癌患者临床分期改变,其中分期升级23例,降级3例.8例分期升级者治疗方案由手术根治性治疗改为姑息性治疗;2例分期降级者进行了根治性手术治疗,并与病理分期一致.除Ⅰ期外,CT扫描后宫颈癌分期诊断的准确率随着分期的升级而上升,其中Ⅱa期86.3%,Ⅱb期88.2%,Ⅲ期及以上100%.结论 螺旋CT是一种对宫颈癌较好的无创性分期诊断方法.     

多层螺旋CT对胰腺癌的术前评估

目的:探讨多层螺旋CT双期增强扫描及图像后处理在胰腺癌手术可切除性研究中的应用价值。方法:对63例胰腺癌患者进行MSCT双期增强薄层横断位扫描,结合多平面重组(MPR)、最大密度投影(MIP)、三维容积演示(VR)等后处理技术,对胰腺癌作出能否切除的术前评估,并以手术结果作为对照和分析。结果:35例患者进行了手术,19例MSCT认为可切除的,实际术中切除15例(可切除率79%);16例MSCT认为不可切除的,实际术中不可切除15例(不可切除率94%)。结论:MSCT对胰腺癌术前可切除性的评估具有重要的临床指导意义。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.